HomeMy WebLinkAboutNETTLETON ACRES #2 LT 11~NAME
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTtt & ENVIRONMENTAL, PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchorage, Alaska 99501 Telephon~- 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WEI_I_ INSPECTION REPORT
GRADE
MAILING ADDRESS
LEGAL DESCRIPTION
i DiSTANOETO: IWe,, /: Z/
Manufacturer
Liq. capacity in gallons I
Manufacturer --
Iw~lm
DISTANCE TO: I
No. of Imnes, I Lengd~ of e~cll hne
/ I.
Top of tile to finish grade
~,~
Type of crib Crib diameter
Deoth
~uildin~ foundation
Absorption area Dwelling
Inside length
Dwelling
Material
~leares[' Fat line
Trench width
Foundation
Total length of lines
aterla beneat~ tile
Depth
Crib depth
Building foundation
Driller
Sewer line
inches
inches
NO. OFBEDROOMS
No, of compartments
Liquid depth
PERMIT NO.
Liquid capacity in gallons
PERMIT NO.
Distance between lines
Total effective absorption area
PERMI¥ NO.
Total effective absorption aree
Nearest lot line
Distance to lot line
PERMIT NO.
Absorpt on area(s)
Septic tank
OTHER
_PI PE MAT E R IA Lk/,~ ¢~L~ F~
SOl L TEST RATING
1 .¢:
INSTALLER
_ Iv~-'k,-.
REMARKS
APPROVED
72-013 (Rev. 3/78)
DATE
LEGAL
/.//
Location .......
..'. ~;,..-..~. ,.. ~.: ~-:..,..~f..~: ...... f~.'..'.'.. ;. '..~ .: ~.. ;. ....................................
Date completed ....... (./.. :5. f...{.f. ...............................................................................
Depth of well ............ /...(: ........................................................................................
, ((//
Size of casing ......... ::; ................................................................................................
Distance to water ........... ~.., ......... : .... ~ ........ -:: ........ :..: ..... N...z ..................................
Distance to water while pumping ........................................................ at rate
of .............. ~.~.'f.;. ....................... 'gallons per hour.
Formation [ from
to'
Driller
DELTA DRILLING COMPANY
SRA BOX 394 B
ANCHORAGE. ALASKA 99507
FIf:'[:'L. t C:FII"~T NC~RM E:F:: I ::.:.;"['Ol.,.I 6h.".:u:36 ["11 LEV
[...IDCi::IT I O~'~ [:'[::ll_l!..FI Pl._.
LI:2:C~FtL L. :1. t NETTLE~TON F~CF?.E:S I..INIT ;2
T"r'F:'E O1= 5;OIL.. FIE3%Of;;:F'TION 5C,'*'S-f'EH Z~;: "I"Fi:ENCH
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TI'lIE [;?.[SgH.JIRED SI;Z:[ OF THE :5OIL.. FIE',SOF;:F"T'!ON Sh"5:T~FI
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TFIE~: LE~:N]3T/-] D I I'"IEN% I or.,I I s THE I._Er..IGTH ,:.' I I'.,! FEET ) OF' THE: T[~!EI'.,IE:F! OR I".:,RFI I NI:::' I E]....D.
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'T'H[:2]:;i:[:2 1' E: iqO SE:T I,.! I DTH FOR
'TH[:'. GI:~'.F:IVI~I.... [:,E~.F'TFI Z:F.i 3"HE HINIr,ll..IH DEPTH O1:::' Ot~?.I::IVE:L
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LJF:'OF,I THE:: TYPE O[= F'IjEtLIC I,.tE:L[ ....
MiNIMI...IH E:,I'.'.=,;TFINC:E F'F?.O!"I fq PF.':IVF!TE !.qE:LL. TO la PR :[ 'v'6FFE: ::2;E:t, IE:".R L. It'.,!E I::2; ;25 F:EEYT' Fli'q£:,
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O1:::' THE IqEL.L. C:Cd"II::'L.E:TI Ol'q.
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la',,,'F:l I LFIE]LI:~ TO I I",I~;LIFiiE F:'Fi:OF'EI:.?. I I".I~;TFILL..FIT I ON.
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I C:[.:::[~:TiF'"r' "['Hf::IT
:t: I l::tM F:F:ff"III...II=I[;i: I.,.IITH THE:
[::Of~:TH E:'T' THE': MI...I!'.4IC:~[:'FILI'I"'*' OF FII",tCHCff:~'.FI~3E.
;2: ! I,.t:[I_L. IN::2;TFII...I.... THE: S',':~,TE]"I IN F'IC:CORDFtNCE: FILTH THE: E:O[:'E:'S.
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f',i:Ei::~:.~; I D[EI',,IC:E: I :ii; R[EP10[:,[.:.'I....EI::, TO
: !;i:;ii:i-" i;iii :,: ¥,::,[..! ......................................
MUNICi'~ALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L. Street, Anchorage, Ata~ka 99501 264-4720
SOILS LOG - PE[RCOLATION TEST
PERFORMED FOR:
LEGAL DESCRIPTION= ~' ~/') '~' /'''//
1
2
3
4
5
6
7
8
9
[] PERCOLATION
TEST
SLOPE
DATE PERFORMED:.
S,TE PLAN '
10
11
12
13
14
15
16
17
18
20
COMMENTS
WASGROUNDWATER //~/0 S
ENCOUNTERED? L
O
P
E
IF YES. AT WHAT
DEPTH?
P Gross Net De~th to · Net
Reading Date,· Time Time _~,.,~ Water Drop , ,,
· '~PERCO LATION RATE
TEST RUN BETWEEN
, FT AND
[minutes/inch)
,, FT
CERTiFiEDBY:/~~ ~_ t ].~,
~ --~ DA ,t: RECEIVED
I NSPECTI ON APPOI NTM ENTS
TIME TIME TIME
DATE DATE DATE
INSPECTOR INSPECTOR I NSP ECTOF~.~
MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCt IORAGE
) DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTIONDEPT. OF
825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL P;X)FLC'[ION
ENVIRONMENTAL SANITATION DIVISION
Telephone 264-4720
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing,
I PHONE
MAIL1NG ADDRESS
PROPERTY RESIDE~ (If different from above)' PHONE
PHONE
MAILING ADDRESS
3. LENDING INSTITUTION I PHONE
I
MAILING ADDRESS
4. REALTOR/AGENT I PHONE
MAILING ADDRESS
5. LEGAL DESCRIPTION
/-o ?/
STREET LOCATION
6, TYPE OF RESIDENCE NUMBER OF~BEDROOMS
~ E~] one '~,.~'] Four
SINGLE FAMILY [] Two Five
[] MULTIPLE! FAMILY [] Three [] Six
[] Other
7. WATER SUPPLY
iNDIVIDUAL*
COMMUNITY
[] PUBLIC UTILITY
* ATTACH WELL LOG. A Well Icg is required for all wells drilled
since June 1975. Por wells drilled prior to that date, give well
depth (attach Icg if available.)
8. SEWAGE DISPOSAL SYSTEM
~8~' INDIVIDUAL/ON-SITE**
[] PUBLIC UTILITY
YEAR ON-SITE SYSTEM WAS INSTALLED.
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010 (Rev, 6~79)
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE NUMBER OF BEDROOMS
(~] SINGLE FAMILY [] ONE [~ THREE [] FIVE [] OTHER
[] MULTIPLE FAMILY [] TWO [] FOUR [] SIX
PERMIT NUMBER
2. WATER SUPPLY
[] INDIVIDUAL DEPTH OF WELL
[] COMMUNITY
DATE DRILLED
[] PUBLIC UTILITY
Connection Verified LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER
F~ INDIVIDUAL/ON -SITE DATE INSTALLED
Connection Verified INSTALLER
[]Septic Tank or E]Holding Tank
Size: /~--~'~ If Tank is homemade SOILS RATING
give dimensions:
TYPE OF TANK MANUFACTURER
TOTAL ABSORPTION AR EA MATERIAL
4, DISTANCES Septic/Holding Tank Absorption Area Sewer Line I Nearest Lot Line
WELL TO:
Absorption Area to nearest Lot Line
5, COMMENTS
[~A'PPROV ED FOR ,~ BEDROOMS
[] CONDITIONAL APPROVAL (letter must accompany certificate}
[] DISAPPROVED
DATE BY
72-010 (Rev. 6/79)